HomeMy WebLinkAbout15-301CITY OF IOWA CITY
410 East Washington Strcct
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319( 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
IDENTIFICATION NO. — 3 L)
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m, to 3 p.m., Monday- Friday)
Failure to complete the "required" information will result in denial of the application
3. Contact Information (REQUIRED)
(All written comm
4a. Chauffeur's License expiration date (REQUIRED) — 11`6l I ILL
b. Taxicab Business Name (REQUIRED) _t -dlfl -t-) 6F
5. Prior experience in transportation of passengers:
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _%
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years?
What happene o e Yarq_tL.(Circle one) UJ) "00 VrI OI ly/ li
Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,
Type of offense Where hen
W`
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide -the T-Mme(s) t )
S .
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Departrinent of Transportatio a valid Chauffeur's license number
1, 02,`/ )(V� ;��7 issued on I I I expiring on l�L(�. I understand that if I
falsely answer any questions in this application, that this application may be denied. I agree that in making this application, I
consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this application, anA further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the pro s' ns of Title 5, 5, h pter 2, of the City Code. (Needs to be )igned in front of a Notary Public)
Signature of Applicant 3J I Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me byt�rlrtL t_. C on this 2-Z day of
�-c(FIti_J_-*b OL)5 1 r
Public in and -for the State
My
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that
there is no information which would indicate that the issuance would be detrimental to the safety, health orwelfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
_,+1_5 r
Expiration date of Chauffeur's license Imo. 01 I21 1201
T
—JtilLci3
Signature of Policb Chief or designee
22215
Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
h>Z4 -,/ k . a� ')
Signature of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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ClerkrfAXID♦ IVBADGEAPPL92014amended,DOC 0312015
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SMARTER I I��fi.Ef I (USTOMER DRIVrN R
Office of Driver Services
PO Box 92041 Cies M1loines, IA 50306-9204
Pham 535-244-5124 1600-55 2-9 921 f Fax- 515,239-1937
www iovradot gav
Certified Abstract of Driving Record
Inquiry Date:
12/9/2015
CDL Permit Issue
DL/ID #:
637XX4837 (1A)
Customer #:
3568804
None
Class:
C
Name:
Chipman, Bobbi
Lynn
Audit #:
7669055
Address:
461 HIGHWAY
1 W APT 30
Issue Date:
01/04/2014
DL Status:
VAL
CDL Status:
Expiration Date:
11/04/2019
City/State:
IOWA CIN, IA
522464215
Endorsements:
NONE
Mailing
461 HIGHWAY
1 W APT 30
Restrictions:
NONE
Address:
Restriction
None
Mailing
IOWA CIN, IA
522464215
Supplement:
City/State:
Date of Birth:
11/4/1985
Sex:
F
History Information
Convictions
CDL Permit Class:
None
CDL Permit Issue
None
Date:
JUR
COL Permit Expiration
None
Date:
Speed _.
CDL Permit
None
Endorsements:
1.02/16/2011
08/09/2011
CDL Permit
None
Restrictions:
'.IA
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit Status:
ELG
CDL Cert Status: None
CDL Med Status: None
Citation Date
Conviction Date
ACD
Explanation
Coonty
JUR
01/03/2011
592
Speed _.
Henry,
IIA
06/16/2011
1.02/16/2011
08/09/2011
'S92
Speed
Johnson
'.IA
09/07/2011
.10/19/2011
S92
(Speed
sJohnson
IA
Name: Chipman, Bobbi Lynn DL/ID: 637XX4837
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the
custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said office,
and that I have been authorized by the Director of the Iowa Department of Transportation to so certify,
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
r -a
ca
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12/9/2015
IOWA z',,f Floa
Offic
Gd :4 l
ces
OBIYE�s�` Iowa eDepof artment eof lTransportation i.. -a
t-
G=%
Name: Chipman, Bobbi Lynn DL/ID: 637XX4837
Uec.22. 2015 IU,U9RM Div of Criminal Investigation No. 4302 P. 2
Frorn:a.-,ty m ,owe {_Dly Clerk c+,noc a10 3666497 12/16/2016 1a -n2 0346 P.002/002
bTATF OF IOWA
@)I Criminal History Recard Cbeek
Request Far@II
To: Iowa Division of Criminal tnvestigalion
5'uppnrt 01tera0mis Bureau, I" Floor
215 C. 7" Street
DesMuinCS, IOWA 50319
(515) 725-6066
(515) 725-6000 Fax
lam
ate Of Birth (hand¢
on;
me
l. I
00 Account Number L4C-1 j,
(Efappliealrlc)
Frmn: CiEy Uf towa Cl[
City Clcrlr'eaftice `--�
41U I';. Washln[:(on street
_Tows L'�tY, IA_52240
Phone: 319-356-5041
Fax: 319-356-5497
1,14 �\ v�
❑Male ]Female I �t3< 13 - C-)Xq
watper /Bjorafaliottr Without a signed waiver from the subject of the request, a complete aminal history record may not
be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by fate, always
Main a waiver slang urg from the subject of the r'anaeat
Waiver Release: l bercbytne pernlissien le above To(
Invesliparlon (DCI). Any erinunat history Oar neer ing my Ilial
WaiverSiennture:
to con ducl an IOWA criminal histnpr record check %villi rte Division of Crinimm
Y06 DCI may Ill: released as allowed by law.
Iowa Criminal Hisfory 1<teeord Check Results
As of /��(l � , a search ofthe provided naive and date of bitlh revealed:
T No 10wa Criminal liisloiy Record found with DC1
Iowa Criminal History ROCOrd atlacbed, DO #
DO ini(ials4-
I)C)-77 (08/25/)0) — ��--
Received Time Dec. 15, 2015 1:31PM NoA920
(Dn use Only)
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